“Be Prepared,” with a “super-Heimlich”

A world-recognized McGill medical scientist, Peter Macklem became my friend through a shared interest in the misdiagnosis of digoxin poisoning in children based on autopsy blood tests. He became my hero when he stood alone as the professor of Medicine at McGill when he was an expert witness at a Royal Inquiry – denying the validity of autopsy digoxin testing as evidence of murder. He wrote the Foreword to “The Nurses are Innocent” which details how false serial murder charges were laid against nurse Susan Nelles of the Toronto Hospital for Sick Children (1980-81). Tragically, Peter died suddenly from food-bolus laryngeal obstruction, a day before Dundurn Press accepted my book’s publication.

Peter’s potentially preventable sudden death inspired thoughts of first aid measures that might eject a stuck food bolus. Emergency treatment of food bolus airway obstruction involves techniques to suddenly increase air pressure in the trachea to eject the bolus. This resembles the physics of a toy popgun (a cork ejects with a “POP!” from a surge air pressure created in the barrel). The Heimlich manoeuvre entails grasping the patient in a bear hug, high around the waist from behind, one fist clasped above the navel. A quick forceful bear hug compresses the upper abdomen and lower ribs, abruptly raising tracheal air pressure, ejecting the stuck food.

Since Peter’s death, I mused about possible simpler more effective “popgun” methods. I kept thinking back to my 1944 Boy Scouts St. John’s Ambulance training for artificial resuscitation for drowning victims, to a forgotten technique from the era before mouth-to-mouth assisted breathing replaced it. One straddled a patient, with the knees on each side of the thighs of the patient who was lying face down with the face to one side. With the palms over the lower posterior ribs, the fingers wrapping around the lower lateral ribs and rocking forwards, one’s weight compressed the thoracic cage causing forced expiration. Rocking backwards released the compression, eliciting passive inspiration. I wondered if a modification of this forced expiration technique could be applied to food bolus impaction. A sudden thrust of one’s weight on the lower chest cage should abruptly raise tracheal airflow and create a surge in air pressure behind the obstruction, duplicating popgun physics, ejecting the obstructing food. This thought lingered in my subconscious mind.

Daydreaming became instant reality while holidaying in mid-August 2014 at Arrowhon Pines, deep in the forest in Algonquin Park. My wife, Bea and I were seated in the rustically elegant dining room, slowly savouring our evening meal when she jumped up clutching her napkin to her mouth and headed for the washroom. In the hallway, she dropped the napkin, gasping for breath, emitting a hoarse wheeze. Instantly recognizing the crisis, I grasped her in a bear hug and administered two powerful Heimlich manoeuvres. No effect!

Thrusting her face down on the floor, I administered a forceful St. John’s Ambulance lower thoracic compression. Again no effect! I repeated an even more powerful thrust (recognizing that broken ribs heal, but death comes suddenly in airway obstruction). The food bolus dislodged! Normal breathing ensued. The crisis evaporated. I acted mechanically – like a robot – performing procedures I had never done before – reacting to the immediacy of a life-or-death situation where there was no option. Subconsciously, I had been just following Lord Baden-Powell’s Scout Laws regarding “Be Prepared “ – “having thought out beforehand any accident or situation that might occur….. you know the right thing to do at the right moment, and are willing to do it.”

Unaware of our surroundings, slowly reality set in. Looking around, we saw three concerned onlookers – who had responded unflinchingly to an appeal from the dining room staff in a crisis – two psychiatrists and a paediatrician. One knelt down on the floor, asking Bea if she was all right, saying she was a paediatrician. Deeply embarrassed, but drawing on her inner sense of humour, Bea managed to utter, “Perhaps I am more in need of a geriatrician.”

On learning of this story, McGill’s dean of medicine, David Eidelman, a long time friend and associate of Peter Macklem at the Montreal Chest Institute, commented that it seems I “had used a ‘super-Heimlich’ by applying force elsewhere more effectively.”

And so it was – the circumstances surrounding the sudden death of a scientist friend I had never met – the physics of a child’s toy – and vintage Boy Scout St. John’s Ambulance First Aid training – combined to save the life of my wife, Bea.

Gavin Hamilton grew up in St. Thomas, Ontario, and attended the University of Western Ontario for medicine. He studied family practice for nine years, obtained a fellowship diploma in radiology, and retired as an assistant professor. He lives in London, Ontario.

Community

Site Help

We acknowledge the support of the Canada Council for the Arts and the Ontario Arts Council for our publishing program. We also acknowledge the financial support of the Government of Canada through the Canada Book Fund and Livres Canada Books, and the Government of Ontario through the Ontario Book Publishing Tax Credit and the Ontario Media Development Corporation.